A 66-year-old asymptomatic man is found to have a 75 percent right internal carotid artery stenosis on duplex scanning performed before coronary bypass surgery. He has never had a stroke or transient neurological deficit. According to the ACAS trial findings, the best management of the carotid stenosis is:
- A Carotid endarterectomy combined with the cardiac operation
- B Carotid artery stenting followed by cardiac surgery
- C Best medical therapy alone ✓
- D Extracranial-intracranial bypass
Correct answer: C. Best medical therapy alone
Explanation
The ACAS trial showed that in asymptomatic carotid stenosis of 60 percent or more, carotid endarterectomy reduced the 5-year ipsilateral stroke risk from about 11 percent to about 5 percent, an absolute benefit of roughly 1 percent per year, provided perioperative stroke and death rates stay under 3 percent. For an asymptomatic patient, best medical therapy with antiplatelet agents, statin, and risk factor control is the accepted standard, and EC-IC bypass showed no benefit in its trial.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.